Various odds and ends today including Russel Brand and a shouty man in a car.
ed: Apologies, forgot the shouty man in a car
Clare Gerada on the strike by junior doctors.
Being a doctor – or any public sector worker – shouldn’t be such a battle. That’s why we must support junior doctors in their planned strikes.
For the last 9 years I have been the medical director of an NHS service providing confidential help to doctors and dentists with mental health problems, seeing a rising number of doctors week on week.
But our patients have changed.
In our early days the ‘typical’ patient was an older male (GP or psychiatrist) with alcohol problems.
Now nearly half of all new patients are under 30 years old. They come to us with depression, anxiety and symptoms akin to posttraumatic stress disorder. Many have worked in the NHS only a few years. They started out bushy tailed and bright eyed, but end up ‘burnt-out’ (a polite euphemism for depression) after only a few years working. Our youngest patients are only a few months qualified and many are in their Foundation years.
Patient after patient talks of feeling betrayed and bewildered by their loss of enthusiasm about a profession that they had strived to enter (often since their early teens). How their desire to care for patients is sapped by every working day. The language they use to describe their work is that of the battlefield. Being on the ‘front-line’, of ‘surviving’ another shift, being ‘at war’ with management. They talk of feeling abandoned by the NHS. Of working intolerable shifts that appear to have been designed by robots with no concept that humans will need to work them. Of having no sustenance – literally and metaphorically – as they try their best to deliver care to patients.
They talk of working in an unforgiving environment – where every error will lead to punishment and where every move is watched and recorded. They describe the fun having gone out of their profession. They say that they cannot see a future any more in medicine.
Hardly surprising therefore that the numbers progressing through training (from the early Foundation Years to the start of specialty training) is reducing. That now nearly half of doctors are not progressing. And that this is against a background of fewer of our brightest entering medicine in the first place.
Our junior doctors are striking for more than pay and conditions – important though these are. Their planned strike is consciously or unconsciously action to shine a light on what is going on within the NHS – to shine a light on the conflict between idealism and industrialization.
Increasing privatisation has changed the relationship doctors have with their patients. Constant reorganisation has fragmented services, and shattered long-standing teams. At a series of NHS listening events I held in 2014, the overwhelming term used by all NHS staff to describe their working environment was ‘Fear’.
The pay of junior doctors has never been good – not when calculated across the hours worked, the responsibilities they have and when compared to their non-medical peers.
But this was part of the compact we all had – we gave our all for our patients and the organisation we worked in gave their all to us – cared for us, nurtured us, trained us. We also knew that the intolerable hours would end as we climbed the medical career ladder. Now all of this has been fractured.
Instilling ‘fear’ in doctors, teachers, nurses and other public sector workers is deliberate government policy – as explicitly set out by Cameron’s policy guru, Oliver Letwin, in 2011.
The new junior doctor contract will erode not just pay but also the current safety net against exploitative hours of work. Saturdays will be counted the same as week-days (tell their children that when they are off school and wanting to see Mum or Dad). Women and others who take career breaks will be discriminated against. Junior doctors have been forced to look into the abyss and chose between pain today (strike action) or pain tomorrow (agreeing to an unfair and unsafe contract). They are being treated as children rather than the committed adults they are – their please ignored, instead accused by Jeremy Hunt of being ‘extreme’, ‘militants’, and even unpatriotic.
The junior doctors are not alone in their discontent. The nurses who are marching this Saturday, the teachers and social workers, in fact most public sector workers have seen insecurity, exploitation, fear, and subtle discrimination as the backdrop to their working lives.
The junior doctors are fighting for fairness for all of these workers. They are leading the charge for a restoration of the values that should drive our public services. For a change by those who employ them – ultimately our Government – who have a moral duty to protect those who care for some of the most vulnerable in society.
Without this change, goodwill will disappear forever and with it the glue that binds our public services together. The government must now stop their bullying tactics and accept that something is profoundly wrong the NHS today and act before it is too late.
This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence.
The junior doctor contract governs the pay and conditions of work from doctors’ foundation year to registrar level. All doctors who are not consultants or fully qualified GPs are considered ‘junior’ doctors. This contract was scheduled for renegotiation, but the British Medical Association (BMA) – the largest representative body of doctors – walked away because the offer on the table was not fair to doctors and not safe for patients.
The government’s initial response was brazen, and threatened to impose the new terms without consultation – a position it has had to water down since the BMA decided to ballot its members for strike action. Here’s why the BMA has done so the first time in 40 years:
Britain’s doctors have had enough. In a stretched and underfunded health system which doesn’t train enough doctors and nurses to meet its own needs – or invest in the infrastructure needed for new hospitals and facilities unless aprivate contractor is taking a nice slice of the pie – the solution seems to have been ‘work harder and take up the slack’. According to the Royal College of Physicians, the NHS “remains reliant on doctors working longer than their contracted hours…the amount of ‘goodwill work’ is increasing year-on-year.”
Trusts struggling to pay their tithes to the private owners of NHS hospital buildings have responded by reducing staff salaries, meaning fewer doctors and nurses are covering more patients and expected to do so for free. The situation has reached crisis point and doctors are experiencing enormous burnout, with more doctors applying to live abroad every year. Into this context came the new contract.
The ‘offer’ of the new contract has been condemned first and foremost as fundamentally unsafe. Just as with the recent tube strike, the new contract threatens to force doctors to work longer and later with fewer safeguards.
The BMA approached negotiations acknowledging financial limitations but determined to improve safety: it wanted no doctor to work more than 72 hours in a week; no more than four nights in a week on-call; a rest day either side of nights before starting back on day shifts; and facilities to sleep-in for those who otherwise make a dangerous long drive home.
The government was unwilling to accept these terms, and furthermore wanted to reduce breaks to just one 30 minute break in a ten hour on-call shift. As a recent viral video asked, could you save a life if you’d been up all night?
The new contract would mean a 15-40% pay-cut depending on your specialism, with GPs and emergency care doctors being some of the hardest hit. Let that sink in.
With wages starting beneath the national median anddecreasing yearly like all public sector pay, and out of pocket expenditure for licensing, exams and indemnities, junior doctors earn significantly less than the tabloids would have you believe. Their reports often use a cunning sleight of hand: taking the figures for the pay of those doctors doing the most private work – GPs who run a private practice and some consultants who run private clinics – and presenting the data as proof of ‘greedy’ public sector workers.
There are two ways doctors’ starting wages increase: extra pay for unsociable hours, and pay advancement as you progress through the ranks of seniority and responsibility. Both of these are under threat in the new contract.
The government has suggested that working from 7am until 10pm Monday to Saturday are sociable hours – and therefore should not be paid extra – which is funny considering MPs just reduced their own working hours and increased their own pay. As for pay progression with seniority, no actual offer was made.
The contract changes penalise those who take time out to start a family and those who work part-time –overwhelmingly affecting women in both cases. Additionally there are concerns that changes to breaks will make work more dangerous for pregnant women. As noted above GPs will be amongst those taking the largest wage cut, one of the few specialisms with more women than men.
More than 200k people signed the petition to debate a vote of no confidence in Jeremy Hunt. He wrongly and infamously implied that doctors don’t work at night or weekends. After blaming the A&E crisis last winter on people attending inappropriately (rather than, say, the reduction of roughly 13k hospital beds over the last five years), Mr Hunt felt it was appropriate to take his own children to A&E rather than wait for an appointment like, you know, the rest of us commoners.
But most of all:
Hunt and the government have shown a complete disdain for even the barest semblance of actual negotiation. When the BMA walked away from negotiations a year ago, it wasn’t as a strategy to get better terms, it was because the negotiations were a farce. It has taken the threat of industrial action for a pathetic attempt at reconciliation to come from the Department of Health, full of vague, unconvincing rhetoric. It is too little, too late. No fruitful discussions can continue with Hunt as health secretary. We have no reason to believe in his word or his competence.
We deserve more. Doctors do not take strike action lightly. Whilst we will always maintain emergency and essential services, the BMA will be balloting its members to strike against the contract in the next month. We hope to see you on the picket lines.
The government is trying to pass a clause in the Care bill today that will allow hospitals to be closed much easier without public consultation.
Stormy scenes are likely in parliament today as the government tries to “rush through” changes that will make it far easier to close hospitals without public consultation. The changes,which OurNHS has campaigned on from the start, now face fierce opposition from doctors, 38 Degrees, the British Medical Association, NHS campaigners and charities.
On Friday Ed Miliband tabled a motion of opposition to the Bill, saying it “includes provisions which could put NHS hospitals at risk of having services reconfigured without adequate consultation and without clinical support”.
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The hospital closure clause gives Trust Special Administrators greater powers including the power to make changes in neighbouring trusts without consultation. It was added to the Care Bill just as the government was being defeated by Lewisham Hospital campaigners, in an attempt to ensure that campaigners could not challenge such closure plans in the future. But the new Bill could be applied anywhere in the country.
Louise Irvine, Chair of the Save Lewisham Hospital campaign, said “If services need redesigning the law must ensure this is with proper and extensive consultation with local people. This process cannot be rushed. Decisions should not be based on the needs of investment banks. What happened to the government promises that in the NHS there would be ‘no decision about me, without me’?”
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OpenDemocracy appears on the Want to make a worthwhile donation this Solstice? page
Ed Miliband commits to doubling the number of homes built each year. The move is likely to prove very popular. I think that he’s correct in recognising development and building as a racket concerned with profiteering. I would also like to see the renovation of properties and the conversion of buildings to homes or other forms of social housing.
Profiteering property developers that hoard land and councils that block developments will be swept aside in a “non-stop drive” to more than double the number of homes being built each year in England, Ed Miliband will promise on Monday.
Attacking “stick-in-the-mud councils”, the Labour leader will say he would order a national planning inspectorate to give priority to local authorities that want to expand if they are being blocked by neighbouring councils refusing to release land.
Under the Labour plans, councils would be empowered to compulsorily purchase land or charge fees if developers fail to build on land for which they have planning permission. Michael Lyons, the chair of Labour’s new independent commission on housing and a former BBC chairman, told the Guardian that Britain needed to recapture the postwar spirit when building homes was the national priority.
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Despite MPs claiming publicly that they object to their intended pay rise, only 10 MPs back a motion to limit their pay rises to 1% to match the public sector.
Almost half a million fewer old and disabled people are receiving care and support from the public purse than would have been the case before the financial crash, according to an expert study.
The research comes as MPs vote on Monday on the coalition’s care bill, which aims to overhaul the care system in England but threatens to tighten still further the rules of eligibility for state support.
Charities and care organisations are calling on ministers to address a “black hole” in social care funding which they say has left the system short of £2.8bn a year that would be necessary to meet people’s needs assessed as “moderate”.
Bridget Warr, chief executive of the United Kingdom Homecare Association, said: “Funding good care which helps people stay in their own home is not only a moral responsibility for any civilised society, but is also cost-efficient as it extends people’s wellbeing, reducing admissions to A&E, and helps people return home from hospital quicker.”
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